Preservation rhinoplasty: the dorsum is preserved

Preservation rhinoplasty is one of the most important rhinoplasty innovations of the past decade. In the traditional approach the dorsum is filed down; in the preservation technique the entire dorsal structure is preserved and lowered from below. Result: more natural lines, less swelling, fewer complications.

Why "preservation"?

In traditional rhinoplasty the dorsal hump is shaved from above using rasps or osteotomy. In this method:

• The dorsum's bone-cartilage roof is entirely removed
• Open roof deformity occurs — a gap between the two lateral bones
• This gap is closed via osteotomy
• Scar tissue at the original hump location may reform (recurrence)

In the preservation technique:

• The dorsum is left untouched as a whole
• Small bone-cartilage pieces are removed from the septum and base
• The dorsum is pushed down — this is known as the "push down" technique
• Natural anatomy is largely preserved

Advantages

• More natural dorsal line: Natural aesthetic unit preserved
• Less swelling: Less skin-bone disruption
• Lower complication risk: Open roof, polly beak deformities reduced
• Faster recovery: Social appearance regained in 3-5 days
• Lower revision rate: Less scar tissue → less rebound

Who is it suitable for?

• Patients with smooth dorsal structure, only excessive height
• Mild-to-moderate dorsal hump
• Patients without significant asymmetry or dorsal deformity
• First-time rhinoplasty (not suitable for revision)
• Patients prioritizing natural results

Limits

• Not for all cases: High humps, dorsal asymmetry, tip reconstruction may require the classical approach
• Surgeon experience required: Push-down technique demands high technical skill
• Tip considered separately: The preservation approach is for the dorsum; tip work uses a separate (closed/open) technique

Closed + preservation combination

Closed rhinoplasty and the preservation approach can be combined — uniting their advantages:

• From closed: scarless result, less swelling
• From preservation: more natural dorsal line, fewer complication risks
• This combination is called "closed preservation rhinoplasty"